Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With Rituximab
In a 159-patient study with follow-up beyond five years, rituximab alone brought most membranous nephropathy patients into remission and preserved kidney function long-term, with estimated 10-year kidney survival above 95%.
Background
Rituximab has become standard of care for membranous nephropathy, but long-term data on hard endpoints such as end-stage kidney disease (ESKD) and major eGFR loss have been limited. This single-center retrospective study followed all patients treated with rituximab between 2000 and 2022.
Key findings
Among 159 patients (median age 58, 76% PLA2R-antibody positive), 140 (88%) attained complete or partial remission, with median time to complete remission of about 23 months. Over median follow-up of 63 months, only 7 patients (4.4%) developed ESKD. Prior immunosuppression and interstitial fibrosis/tubular atrophy of 25% or more independently predicted failure to respond.
Clinical implications
Long-term kidney survival with rituximab (97% at 5 years, 95% at 10 years) compares favorably with historical cyclophosphamide-steroid outcomes, supporting rituximab as durable first-line therapy while flagging advanced fibrosis and prior immunosuppression as markers of poorer response.
Category
Research
Source
Kidney International Reports
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